Provider Demographics
NPI:1639146848
Name:FREEDMAN, GABRIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MCGRATH HWY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4607
Mailing Address - Country:US
Mailing Address - Phone:617-472-4220
Mailing Address - Fax:617-472-2598
Practice Address - Street 1:112 MCGRATH HWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4607
Practice Address - Country:US
Practice Address - Phone:617-472-4220
Practice Address - Fax:617-472-2598
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADC1915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA352418OtherHPHC PROVIDER#
MA760406OtherTUFTS PROVIDER #
MA1610031OtherMASSHEALTH PROVIDER #
MAY36387OtherBCBS PROVIDER #
MA760406OtherTUFTS PROVIDER #
MAY45010Medicare ID - Type UnspecifiedPROVIDER NUMBER